<!DOCTYPE html>
<html xmlns:th="http://www.thymeleaf.org">
<!-- 弹出层自定义样式  -->
<!-- <link th:href="@{/statics/pulgins/layer/skin/default/layer.css}" rel="stylesheet" /> -->
     <form class="form-horizontal form-label-left input_mask">
        <div class="col-md-6 col-sm-6 col-xs-12 form-group has-feedback">
          <input type="text" class="form-control has-feedback-left" id="inputSuccess2" placeholder="First Name">
          <span class="fa fa-user form-control-feedback left" aria-hidden="true"></span>
        </div>

        <div class="col-md-6 col-sm-6 col-xs-12 form-group has-feedback">
          <input type="text" class="form-control" id="inputSuccess3" placeholder="Last Name">
          <span class="fa fa-user form-control-feedback right" aria-hidden="true"></span>
        </div>

        <div class="col-md-6 col-sm-6 col-xs-12 form-group has-feedback">
          <input type="text" class="form-control has-feedback-left" id="inputSuccess4" placeholder="Email">
          <span class="fa fa-envelope form-control-feedback left" aria-hidden="true"></span>
        </div>

        <div class="col-md-6 col-sm-6 col-xs-12 form-group has-feedback">
          <input type="text" class="form-control" id="inputSuccess5" placeholder="Phone">
          <span class="fa fa-phone form-control-feedback right" aria-hidden="true"></span>
        </div>

        <div class="form-group">
          <label class="control-label col-md-3 col-sm-3 col-xs-12">Default Input</label>
          <div class="col-md-9 col-sm-9 col-xs-12">
            <input type="text" class="form-control" placeholder="Default Input">
          </div>
        </div>
        <div class="form-group">
          <label class="control-label col-md-3 col-sm-3 col-xs-12">Disabled Input </label>
          <div class="col-md-9 col-sm-9 col-xs-12">
            <input type="text" class="form-control" disabled="disabled" placeholder="Disabled Input">
          </div>
        </div>
        <div class="form-group">
          <label class="control-label col-md-3 col-sm-3 col-xs-12">Read-Only Input</label>
          <div class="col-md-9 col-sm-9 col-xs-12">
            <input type="text" class="form-control" readonly="readonly" placeholder="Read-Only Input">
          </div>
        </div>
        <div class="form-group">
          <label class="control-label col-md-3 col-sm-3 col-xs-12">Date Of Birth <span class="required">*</span>
          </label>
          <div class="col-md-9 col-sm-9 col-xs-12">
            <input class="date-picker form-control col-md-7 col-xs-12" required="required" type="text">
          </div>
        </div>
        <div class="ln_solid"></div>
        <div class="form-group">
          <div class="col-md-9 col-sm-9 col-xs-12 col-md-offset-3">
            <button type="button" class="btn btn-primary">Cancel</button>
			<button class="btn btn-primary" type="reset">Reset</button>
            <button type="submit" class="btn btn-success">Submit</button>
          </div>
        </div>
    </form>
<!-- <div class="model_window">
    <form class="form-horizontal" id="userForm" action='' method="post">
        <div class="row row_nomargin">
            <div class="form-group col-sm-6">
                <label for="customerName" class="col-sm-4 control-label require">客户名称</label>
                <div class="col-sm-8">
                    <div class="input-group">
                        <input type="hidden" id="agentId" value=""/>
                        <input id="customerName" type="text" class="form-control" name="customerName" readonly="readonly" placeholder="请选择客户名称"/>
                        <input id="customerId" name="customerId" type="hidden"/>
                        <span href="#" id="customerNameChoice" class="input-group-addon">选择</span>
                    </div>
                </div>
            </div>

            <div class="form-group col-sm-6">
                <label for="contactor" class="col-sm-4 control-label require">业务员</label>
                <div class="col-sm-8">
                    <div class="input-group">
                        <input type="hidden" id="salerId" name="salerId" />
                        <input id="ownUserName" type="text" class="form-control" name="ownUserName" readonly="readonly" placeholder="请选择业务员"/>
                        <span href="#" id="salerNameChoice" class="input-group-addon">选择</span>
                    </div>
                </div>
            </div>
        </div>
        
        <div class="row row_nomargin">
            <div class="form-group col-sm-6">
                <label for="sex" class="col-sm-4 control-label require">产品系列</label>
                <div class="col-sm-8">
                    <select class="input-sm form-control"  id="seriesId" name="seriesId">
                    </select>
                </div>
            </div>
            
            <div class="form-group col-sm-6">
                <label for="sex" class="col-sm-4 control-label require">套餐类型</label>
                <div class="col-sm-8">
                    <select class="input-sm form-control"  id="catalogId" name="catalogId">
                        <option value="">请选择</option>
                    </select>
                </div>
            </div>
        </div>

        <div class="row row_nomargin">
            <div class="form-group col-sm-6">
                <label for="sex" class="col-sm-4 control-label require">套餐系列</label>
                <div class="col-sm-8">
                    <select class="input-sm form-control"  id="productId" name="productId">
                        <option value="">请选择</option>
                    </select>
                </div>
            </div>

            <div class="form-group col-sm-6">
                <label for="sex" class="col-sm-4 control-label ">套餐版本</label>
                <div class="col-sm-8">
                    <select class="input-sm form-control"  id="comboId" name="comboId" >
                        <option value="">请选择</option>
                    </select>
                </div>
            </div>
            
            <input type="hidden" class="input-sm form-control" id="period" name="period"
                    placeholder="购买年限" maxlength="10" value="0" >
            <input type="hidden" class="input-sm form-control" id="presentPeriod" name="presentPeriod"
                    placeholder="赠送年限" maxlength="10" value="0" >
        </div>

        <div class="row row_nomargin">
            <div class="form-group col-sm-6 mengdian">
                <label for="quantity" class="col-sm-4 control-label" >赠送门店</label>
                <div class="col-sm-8">
                    <input type="text" class="input-sm form-control" id="presentQuantity" name="presentQuantity"
                    readonly="readonly"  placeholder="赠送门店" maxlength="10" value="0" >
                </div>
            </div>

            <div class="form-group col-sm-6 mengdian">
                <label for="quantity" class="col-sm-4 control-label require">购买门店</label>
                <div class="col-sm-8">
                    <input type="text" class="input-sm form-control" id="quantity"  name="quantity"
                    placeholder="购买门店" maxlength="10" value="0" >
                </div>
            </div>
        </div>

        <div class="row row_nomargin">
            <div class="form-group col-sm-6">
            <label for="level" class="col-sm-4 control-label">套餐金额</label>
            <div class="col-sm-8">
                <input type="text" class="input-sm form-control" id="bizSumPrice"  name="bizSumPrice"  
                readonly="readonly" placeholder="0.00" maxlength="20">
            </div>
            </div>
            
            <div class="form-group col-sm-6">
                <label for="level" class="col-sm-4 control-label">服务费用</label>
                <div class="col-sm-8">
                    <input type="text" class="input-sm form-control" id="servicePrice"  name="servicePrice"  
                    readonly="readonly" placeholder="0.00" maxlength="20">
                </div>
            </div>
        </div>

        <div class="row row_nomargin">
            <div class="form-group col-sm-6">
            <label for="level" class="col-sm-4 control-label">总金额</label>
            <div class="col-sm-8">
                <input type="text" class="input-sm form-control" id="totalPrice"  name="totalPrice"  
                readonly="readonly" placeholder="0.00" maxlength="20">
            </div>
            </div>
            <div class="form-group col-sm-6">
                <label for="level" class="col-sm-4 control-label">申请时间</label>
                <div class="col-sm-8">
                    <input type="text" class="input-sm form-control" id="applyDate" name="applyDate"
                    readonly="readonly"  placeholder="申请时间" maxlength="20">
                </div>
            </div>
        </div>

        <div class="row row_nomargin">
            <div class="form-group col-sm-6">
            <label for="level" class="col-sm-4 control-label require">微盟用户名</label>
            <div class="col-sm-8">
                <input type="text" class="input-sm form-control" id="prodUserName" name="prodUserName"
                 placeholder="微盟用户名">
            </div>
            </div>

            <div class="form-group col-sm-6">
                <label for="level" class="col-sm-4 control-label ">密码</label>
                <div class="col-sm-8">
                    <input type="password" class="input-sm form-control" id="password"  name="password"
                    placeholder="密码" maxlength="20">
                </div>
            </div>
        </div>

        <div class="row row_nomargin">
            <div class="form-group col-sm-6">
            <label for="level" class="col-sm-4 control-label ">注册手机号</label>
            <div class="col-sm-8">
                <input type="text" class="input-sm form-control" id="telephone" name="telephone"
                 placeholder="注册手机号" maxlength="20">
            </div>
            </div>

            <div class="form-group col-sm-6">
                <label for="contactor" class="col-sm-4 control-label require">客户联系人</label>
                <div class="col-sm-8">
                    <select class="input-sm form-control"  id="customerContactId" name="customerContactId">
                        <option value="">客户联系人</option>
                    </select>
                </div>
            </div>
        </div>

        <div class="row row_nomargin">
            <div class="form-group col-sm-6">
            <label for="level" class="col-sm-4 control-label require">要开通时间</label>
            <div class="col-sm-8">
                <input type="text" class="input-sm form-control" id="demandDate" name="demandDate"
                placeholder="要求开通时间" maxlength="20">
            </div>
            </div>
            
            <div class="form-group col-sm-6">
                <label for="level" class="col-sm-4 control-label">业务结束时间</label>
                <div class="col-sm-8">
                    <input type="text" class="input-sm form-control" id="orderEndDate" name="orderEndDate"
                    readonly="readonly"  placeholder="业务结束时间" maxlength="20">
                </div>
            </div>
        </div>

        <div class="row row_nomargin">
            <div class="form-group col-sm-6">
                <label for="level" class="col-sm-4 control-label ">回款金额</label>
                <div class="col-sm-8">
                    <input type="text" class="input-sm form-control" id="actualFee"  value='0' name="actualFee"
                    placeholder="0.00" maxlength="20">
                </div>
            </div>
        </div>

        <div class="form-group col-sm-12"> 
            <label for="industry" class="col-sm-2 control-label">备注</label>
            <div class="col-sm-9">
               <textarea class="form-control" rows="3" id="remark" name="remark"></textarea>
            </div>
        </div>

    </form>
</div> -->
</html>